Monday, June 21, 2010

Anesthesia referral requirment

Prior Authorization and Referral Requirements

Anesthesiology procedure codes generally do not require prior authorization.
When filing claims for recipients enrolled in the Patient 1st Program, Patient 1st Billing Manual to determine whether your services require a referral from the Primary Medical Provider (PMP).

NOTE : Consults performed in the inpatient hospital setting do not require a Patient 1st referral. Consults performed in a setting other than inpatient hospital require a Patient 1st referral.


Cost Sharing (Copayment)

Copayment amount does not apply to services provided by Anesthesiologists, Certified Registered Nurse Anesthetists or Anesthesiology Assistants.

Completing the Claim Form

To enhance the effectiveness and efficiency of Medicaid processing, providers should bill Medicaid claims electronically.

Providers who bill Medicaid claims electronically receive the following benefits:

• Quicker claim processing turnaround
• Immediate claim correction
• Enhanced online adjustment functions
• Improved access to eligibility information

Refer to Appendix B, Electronic Media Claims Guidelines, for more information about electronic filing.
 NOTE : When filing a claim on paper, a CMS-1 500 claim form is required. Medicare- related claims must be filed using the Medical Medicaid/Medicare-related Claim Form.

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